Health and Quality of Life Outcomes 2008, 6:92
doi:10.1186/1477-7525-6-92

Published: 5 November 2008

Abstract

Background

Participation restriction is defined as "problems an individual may experience in
involvement in life situations" and refers to the personal and societal consequences
of health conditions. There is a growing interest in participation restriction because
(i) problems with work or looking after others may be more concerning to individuals
than the signs and symptoms of health conditions and (ii) even when poor health persists,
participation may still be maintained. The natural history of participation restriction
in the general population is unknown and the aim of this report is to describe change
in status of person-perceived participation restriction over three years in community-dwelling
adults aged 50 years and over.

Method

Prospective cohort study (baseline and 3-year follow-up) using postal questionnaires
mailed to a population-based sample of older adults. Responders were included in this
study if they completed all items of the Keele Assessment of Participation at baseline
(n = 6965). Estimates of onset and persistence of person-perceived participation restriction
at 3-year follow-up were calculated for any and for each aspect of life in the sample
as a whole, and then by age and gender using attrition re-weighted logistic regression
to take account of sample attrition.

Results

In the whole sample of 6965 persons, overall participation status at three years was
unchanged in 69%, and changed in 31%. Of 3431 persons with no restriction at baseline,
it is estimated that 29.8% (95% confidence interval: 27.6%, 32.0%) would report restriction
in at least one aspect of life at 3-year follow-up. Of 3534 persons who had baseline
restriction, it is estimated that 68.8% (66.2%, 71.3%) would report continuing restriction
in at least one aspect of life after 3 years. Onset and persistence both increased
with age, and were most frequently recorded for restricted mobility outside the home.

Conclusion

Although most older persons do not change their overall participation status during
a three-year period, change does occur which implies that population approaches to
improving participation can be sought. Both onset and persistence of person-perceived
participation restriction are more common the older the age-group.